Tag Archives: endgame

Clive Bates has just published an excellent analysis of tobacco control’s “endgame” fantasies, specifically about a special issue on the topic in the journal entitled Tobacco Control (at least they were honest enough to give the journal a title that says “this is all about supporting a special-interest political position rather than doing honest science”). I wanted to add a few additional thoughts to what he wrote. Bear with me through a few musings before I get to the substance evoked in the dramatic title.

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A few days ago I mused about the recent issue of the fantasy zine, Tobacco Control, that was devoted to “visionaries” talking about how to bring about the elimination of smoking, or its health effects, or the industry, or all tobacco product use — they are not really clear about what they mean by “endgame”. What is clear, as I noted, is that they did not choose their metaphor well: The endgame is the phase in a chess match when everything gets smaller, simpler, and puzzle-like, whereas the world of tobacco — pretty static for decades in most populations — is far more populous and complicated than ever before. Moreover, they tend to use the word to refer to what they perceive to be an inevitable victory, whereas an endgame is only played when victory is uncertain.

In the comments on that post, Chris Price pointed out how absurd the following claim from Ken Warner appears if you stop to think about it:

The continuing scourge of tobacco-produced disease is unlikely to yield to today’s evidence-based interventions.

I did not think about it until Chris pointed out how absurd it is, since it seems to translate into:

We can’t reduce disease with methods that are shown to work.

It certainly does read that way, doesn’t it? Pretty funny.

Searching for some benefit of the doubt about the statement not being absurd, it might lie in the following. Taking “yield” as its meaning of “surrender” rather than merely of “back off”, the statement is that the methods will not result in elimination of tobacco use, and thus the exercise in brainstorming to come up with new and creative methods of creeping prohibition. There are several problems with the claim, even giving the benefit of the doubt about what it really means:

It implies that some miraculous new method will cause people to stop engaging in consumption that they choose in spite of the heavy costs. We can believe this because, um, it has worked so well for other drugs? Warner is too good an economist to make this mistake.

What has got to be, by any reasonable account, the second most effective evidenced based method — harm reduction — works remarkably well at eliminating smoking and disease. Not 100% for either, but impressive nonetheless. (First is basic education about the risks, that causes most people to rationally avoid the choice. Third is taxes or other purchase price increases. Every other intervention has effects that are down in the noise, and the evidence that supposedly shows they matters is largely a joke.) THR was barely mentioned by the geniuses who were looking for ideas.

The phrase “evidenced based”, when used in the tobacco control context, is inherently a joke. They use that word to basically mean “someone in our industry ginned up something that kind of looks like science and asserted the conclusion that the intervention works”. That is why they consider approximately useless pharmacological therapy and fiddling with the packaging to be “evidenced based” and THR to not be — because the overwhelming evidence about THR does not come from members of their industry (by definition: anyone who produces evidence that is not part of their prohibitionist agenda is ejected from their team).

In short, they are trying to identify wild new approaches to win the “endgame” that are not backed by any evidence because the evidence shows that every approach other than harm reduction has run its course. And harm reduction, well, that just does not count because it is not their approach. Tobacco improvement is not tobacco control; it leaves tobacco/nicotine users and manufacturers reasonably happy, and we cannot have that.

But the actual endgame is a time when you can think through every move. In the middle game in chess, you can win with a wild “?!” move (the symbol for a “dubious move” — seemingly stupid, but perhaps a brilliant stroke), but in the end game, a bad move is a bad move. And having no move at all, well…

Your move, tobacco control.

The other point that I made is that in the endgame, after most of the pieces are gone, it is mostly about the kings and pawns — the primary stakeholders and the grassroots, to torture the metaphor a bit more. So add some grassroots and…

Tobacco control wear the black hats, of course. White or black to move.

It looks like they have just as much grassroots support. But the little differences like h6 — or, say, the difference between people who live THR or are motivated by wanting to help and those who are only motivated by ignorance and/or hatred — matter.

Postscript (to avoid limiting this post to the few people who are interested in both THR and endgame puzzles, and to either enlighten or bore those not in the second category — spoiler alert for those who want to think through the puzzle first): The first graphic is the classic illustration of the “zugzwang” situation where someone has to move but any move loses (in this case, that is true no matter whose move it is). The second graphic riffs on that combination with a contrived position where the winner will be whoever can make the last move with the pawns on the right, forcing the other to move his king. No matter whose move it is, white can make the last pawn move thanks to the tiny difference in the starting positions. However, it turns out that this puzzle was crafted with a flaw that the author did not intend, such that black can actually win by abandoning the standoff to the left and bringing the king across to attack the “grassroots” directly at just the right time. With that cautionary observation, I promise to stop torturing this poor metaphor.

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The tobacco control industry’s house organ pseudo-journal, Tobacco Control, just released a special issue about what they call the “endgame”, which is their code word for the elimination of all of tobacco/nicotine use.

It is kind of a funny choice of words, since the word derives from the phase of a chess match where there are few pieces left on the board and a decent player can analyze every possible set of moves with greater certainty than earlier in the game. This is rather unlike the situation with tobacco/nicotine today where there are more options, more companies, more tobacco control activists, more real public health and consumer advocates (those of us supporting harm reduction and such), and — most notably — more smokers than there have been ever before, and where there is far less certainty about what will happen next. Most of those who use the term seem to be looking for a something more like the military concept of “mop up”, where victory is assured but some final actions are required.

On the other hand, the more I think about it, the clearer it becomes that they accidentally got something right in this case: When a chess match between serious players has an endgame (rather than one player resigning), it means that a balance still exists and the outcome is yet to be determined. If someone’s victory is already assured, there will be no endgame. Moreover, the endgame is (roughly) defined as the time when the removal of other pieces makes the pawns particularly important and the kings become active fighters rather than just hiding from the action. This seems like a pretty good metaphor for the rise of grassroots activism against the power brokers and for the emergence of active involvement of the primary stakeholders, the consumers. The more I think about it, the more I really like that. Bring on the endgame!

Anyway, I am not sure I have the stomach to read through most of the articles in that issue, though there is probably a month’s worth of the typical tired anti-THR lies to be found in them. I will count on some of you to highlight any high points (which probably really means lowpoints). But I did read the short introduction by Kenneth E Warner, the Michigan professor who organized the conference that led to this collection of papers, and his anti-THR lies probably pretty much sum up what else is to be found there.

Ken is a smart and generally honest researcher, and was one of my mentors during my postdoc about 17 years ago. For quite a while in the 2000s, some of us working on THR thought that he was the most likely candidate among the card-carrying respected insiders of tobacco control to seriously embrace harm reduction and say “be damned” to the ANTZ special interests. I also remember that for a few years, he repeated something I told him during my postdoc: I had thought about doing more work on smoking-related policy and science, but with people like him already in the space, there seemed like there was not much more to contribute that would be useful. When I said that, I was half right: Brad Rodu had already released his groundbreaking work on THR, though most of us in public health did not have the slightest idea about it, which made clear that there was a lot of new, interesting, innovative, and helpful work to be done. However, I was right in my assessment that every other avenue of legitimate science about smoking was pretty much done by then; there has been approximately zero legitimate analysis any consequence since that time.

Alas, Warner never came out in favor of harm reduction, which brings us back to his recent paper, which asserts:

The continuing scourge of tobacco-produced disease is unlikely to yield to today’s evidence-based interventions. Several public health visionaries have introduced tobacco endgame proposals with the goal of substantially reducing, and perhaps entirely eliminating, the toll of tobacco.

He uses the anti-THR lie that “tobacco”, rather than smoking, is a major cause of disease. More importantly, he implicitly claims (several times) that THR is not evidenced-based, one of the two or three biggest anti-THR lies. The reality, of course, is that the evidence does not support the claim that current tobacco control tactics — more aggressive use of drugs, manipulation of packaging, and various other restrictions — do much more than torture smokers. The evidence is pretty sketchy about whether further education (in already educated populations) makes any difference or what the effects of even higher taxes and similar quasi-bans will do (there cannot be much evidence about something that has never been tried, after all). But, but contrast, the evidence that THR can reduce smoking and thus disease is overwhelming, at both the individual and population levels.

As for that last quoted sentence, the terms “visionary” and “public health” give far too much credit for the authors of the other papers in the issue and what appear — based on a quick review — to be the same tired old useless welfare-lowering and/or prohibitionist policies. Even the paper by Lynn Kozlowski, long the tobacco control industry’s pet harm reduction advocate (i.e., the guy they brought in for their staged “debates” about harm reduction rather than dare hear from those of us who were the real advocates for THR), barely mentions harm reduction and does not acknowledge its potential.

Interestingly, Warner fails entirely to even mention THR, let alone point out that it is the most important phenomenon in the area today, something that he surely realizes. Perhaps he did not want to risk offending his friends and patrons by even acknowledging it (very much like the last time I ran into him, at a Society for Research on Nicotine and Tobacco conference nine or ten years ago — after I had become a visible proponent of THR but before the U.S. SRNT stopped allowing us proponents to present — where he literally distanced himself from me, practically running away to avoid being seen talking to me). Yet at the same time, he acknowledges that “something new, bold and fundamentally different from the tried-and-true” is needed. Funny that.

Fortunately, as with actual endgames, one player does not get to just decide how it will play out. And unlike with the opening in chess, where following memorized long-established sequences is the norm, or the middle game where most players make use of general heuristics about what positions are better, in the endgame the exact ramifications of each move are thought out precisely. It is pretty clear that the ANTZ have little idea how to play in that world.

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Tobacco Harm Reduction (THR)

THR is the public health strategy of encouraging smokers to switch to low-risk alternatives like smokeless tobacco and e-cigarettes. It is the only proven method for reducing smoking below about a fifth of the population once it becomes established. (So why would anyone be anti-THR? See the "About" page.)

The continuing scourge of [smoking]-produced disease is unlikely to yield to today’s "evidence-based" interventions. (scare quotes added) Kenneth E Warner; see post if the implications are not obvious

If someone says the sky is green, you prove that it’s actually blue, and the next day he comes back once again insisting that the sky is green, and this happens repeatedly, you eventually have to acknowledge that mannerly debate about the color of the sky just isn’t enough; you have to go meta, and talk about the fact that this guy and his friends just aren’t in the business of honest discussion. Paul Krugman

He who is merciful to the cruel will become cruel to the merciful. Ancient Midrash